血尿酸和细胞间黏附分子1对2型糖尿病颈动脉内膜中层厚度的影响

摘要

Objective To study the effect of serum uric acid and ICAM-1 on intima media thickness (IMT) of carotid artery in patients with type 2 diabetes mellitus(T2DM) accompanying carotid atherosclerosis (CA) by investigating their correlation. Methods Eighty patients with T2DM were divided into DM accompanying CA group (CA group, n = 40) and simple DM group (control group,n = 40). Serum uric acid and ICAM-1 levels,systolic and diastolic pressure,levels of fasting plasma glucose(FPG) ,fasting insulin(FINS) ,glycosylated hemoglobin(HbAlc) , 2 h postprandial plasma glucose(2 h PG),2 h postprandial insulin(2 h INS) , HDL-C, LDL-C,TC,TG, sugar .and lipid metabolism,and IMT of carotid artery in two groups were measured and anlyzed. Body mass index(BMI) and insulin resistance index(HOMA-IR) were calculated. Results The IMT of carotid artery,serum uric acid and ICAM-1 levels,systolic pressure,BMI,levels of TG,TC,LDL-C, HbAlc,FPG,2 h PG,FINS,2 h INS,and HOMA-IR were significantly higher in CA group than in control group(P<0. 05 or P<0. 01). The serum uric acid and ICAM-1 levels were closely related with the IMT of carotid artery(P<0. 01)and were the first to enter the stepwise multiple regression equation as the major independent influencing factors for CA. Conclusion Metabolic disorder,insulin resistance, vascular endothelial dysfunction and inflammatory reaction are more common in patients with T2DM accompanying CA than in those not accompanying CA. Early combined measurement of serum uric acid and ICAM-1 levels helps to predict vascular lesions in patients with DM.%目的 探讨2型糖尿病合并颈动脉粥样硬化(CA)患者血尿酸、细胞间黏附分子1(ICAM-1)与颈动脉内膜中层厚度(IMT)的关系.方法 选择2型糖尿病患者80例,根据诊断分为糖尿病合并颈动脉粥样硬化组(CA组)40例和单纯糖尿病组(对照组)40例,检测分析2组患者血尿酸、ICAM-1、收缩压、舒张压、空腹血糖、空腹胰岛素、糖化血红蛋白、餐后2h血糖、餐后2h胰岛素、HDL-C、LDL-C、TC、TG等糖、脂代谢指标及颈动脉IMT的水平差异.同时计算体重指数、胰岛素抵抗指数(HOMA-IR).结果 CA组颈动脉IMT、血尿酸、ICAM-1、收缩压、体重指数、TG、TC、LDL-C、糖化血红蛋白、空腹血糖、餐后2h血糖、空腹胰岛素、餐后2h胰岛素、HOMA-IR均明显高于对照组(P＜0.05,P＜0.01).血尿酸、ICAM-1与颈动脉IMT密切相关(P＜0.01),作为CA的主要独立影响因素最先进入多元逐步回归方程.结论 2型糖尿病合并CA患者较无CA的糖尿病患者存在更明显的代谢紊乱、胰岛素抵抗、血管内皮功能障碍及炎性反应,早期联合检测血尿酸、ICAM-1有助于对糖尿病人群发生血管病变进行预测.